The goals of this career development award are three-fold: 1) to provide training to Juan Huang, PhD OD to become an independent clinician-scientist; 2) to investigate whether adding 0.01% low concentrate atropine to soft bifocal contact lens wear will result in a greater effect of slowing myopia progression than administering soft bifocal contact lens alone in children; and 3) to evaluate the relationship between short-term changes in choroidal thickness and long-term regulation of myopia progression and ocular growth. A five-year career development plan is proposed, including formal coursework in clinical and translational science, as well as collaboration with accomplished mentors who are experts in specific areas related to the proposed research project. The proposed study is aligned with NEI's objective to evaluate the efficacy of potential treatments, such as pharmacological approaches, special spectacles, and contact lenses, for slowing the progression of myopia. Both atropine and soft bifocal contact lenses have been shown to slow myopia progression, and both can cause changes in choroidal thickness. But the relationship between these mechanisms is unclear. The central hypothesis to be tested is that atropine and soft bifocal contact lenses each exert their anti-progression actions through a common pathway that involves the choroid. If this is correct, then adding atropine treatment to soft bifocal contact lens wear will lead to a more effective slowing of myopia progression than prescribing soft bifocal contact lenses alone due to the additive effects in the common pathway. To test the hypothesis, I propose a clinical study, which would be an ancillary study of a multi-center, randomized clinical trial, the Bifocal Lenses In Nearsighted Kids (BLINK) Study (U10EY023208) chaired by my primary mentor. The BLINK Study compares myopia progression between subjects who wear single vision contact lenses and those wearing soft bifocal contact lenses. I will enroll an additional 49 subjects that are age-matched with the participants who are wearing +2.50D add soft bifocal contact lenses in the BLINK Study. The subjects I enroll will wear +2.50D add soft bifocal contact lenses in combination with daily administration of one drop of 0.01% atropine in each eye for three years. The rates of myopia progression and axial elongation will be compared to the rates in participants who are receiving treatment with +2.50D add soft bifocal contact lenses alone in the BLINK Study. Two specific aims will be addressed: Aim 1: To test whether the combined treatment of 0.01% atropine and soft bifocal contact lens wear produces slower myopia progression and axial elongation compared to soft bifocal contact lenses alone over 3 years. Aim 2: To test whether early changes in choroidal thickness can be used as predictors of long-term myopia progression / axial elongation. The results of this study will have significant implications for future studies to develop and test new therapeutic regimes that optimize the effect of myopia control through combined pharmacological and optical interventions. The outcomes will also aid in understanding the potential role of short-term changes of choroidal thickness in long- term regulation of myopia progression and ocular growth.